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Friday July 30,2010

Managing a Challenging Elder, Part 2

by Jacqueline Marcell

Managing A Challenging Elder, Part 2

The 10 Warning Signs of Dementia

(Reprinted with permission of the Alzheimer's Association.)

Recent memory loss -- your loved one may ask you the same question over and over, look at a beloved granddaughter and ask her name, or forget that they just told you that story and tell you again.

Difficulty performing familiar tasks -- such as tying a necktie or shoelaces, or being unable to do the knitting they have enjoyed for many years.

Problems with language using the wrong word or unable to remember the right word to use.

Disorientation of time and place -- mistaking a time period of hours for days, or giving incorrect directions in the town they have lived in for many years.

Poor or decreased judgment for example, while babysitting they may completely forget about the child they are supposed to be watching.

Problems with abstract thinking -- inability to balance a checkbook, adding becomes difficult or they may insist that a one-dollar bill is a 20-dollar bill.

Inappropriate misplacing of things -- you might find the wristwatch in the sugar bowl, the iron in the microwave, or a hat in the freezer.

Rapid mood swings -- switching from tears to anger for no apparent reason.

Changes in personality -- you may notice a tendency toward fear and paranoia.

Loss of initiative -- your loved one may not want to get out of bed, withdraws socially or says they don?t want to live anymore.

Behavior Modification Techniques

Once the brain chemistry is balanced for slowing down the dementia, and the often-present depression is treated with an anti-depressant, and the possible aggression is medically treated, behavior modification can be used on a challenging elder if they are still in the early stage of dementia and short-term memory is still relatively good.

As amazing as it sounds, the use of tough love, coupled with rewards and consequences, worked to turn around the most obstinate man on the planet: my father, even with the onset of dementia. By being 100% consistent, never rewarding his bad behavior and using tons of praise to encourage his good behavior, he finally changed his life-long behavior patterns of screaming and yelling to get his way--the majority of the time. He finally learned that he could (as Mom would say), "catch more flies with honey than vinegar."

We learned not to argue with him, and practiced using distraction instead. We developed a calm attitude, used direct soothing language and gave simple directions. Since he loved the affection he got for good behavior and hated that we walked away from him when he was yelling at us, he gradually started to behave better and finally accepted the changes we were making to help him. By validating his frustrated feelings, giving him a sense of control over as much as we could, he felt more in charge of his own life and there was less frustration for him.

Adult Day Health Care

Once we got my father chemically and behaviorally balanced, Adult Day Health Care turned out to be the answer to getting my parents out of bed 23 hours a day "waiting to die."